What are my options?

Because mesothelioma is a rare disease, many physicians have little experience with treatment. This lack of familiarity may add to the stress of the diagnosis for the patient. The best recourse is to seek out the best care possible for your treatment. Several centers around the country such as The MD Anderson Cancer Center, The Memorial Sloan-Kettering Cancer Center, and the Dana Farber Cancer Institute specialize in cancer treatment and have the most experienced physicians. Having a physician directing your treatment who is experienced with mesothelioma is extremely important. Your physician should guide you through the important decisions about treatment options based on personal experience.

Treatment of mesothelioma is divided into three general categories that will be summarized below. There is no “standard” therapy. Combinations of the major treatment modalities are often used. Unfortunately, the response rates for many modes of treatment are low. Ongoing research is endeavoring to increase response rates to therapy and ultimately cure this disease.

Chemotherapy

A chemotherapeutic drug called Cisplatin along with a few agents were used in trials as single agents. The response rates were low at 10-20%. More recently a newly approved drug called Pemetrexed (Alimta) has been used in conjunction with Cisplatin achieving response rates of around 41%. Folic acid and vitamin B-12 are given to counteract the adverse effects of Pemetrexed. This 2 drug regimen has emerged as the standard drug combination.

Radiation

High dose radiation has been used to treat the chest pain associated with mesothelioma. Up to 50% experienced a decrease in pain. Radiation has not been shown to increase survival time.

Surgery

Two types of surgery are sometimes performed as treatment of mesothelioma. The first type called Pleurectomy with decortication involves cutting open the two layered pleural membrane surrounding the lung and removing cancerous overgrowth areas. The pleura is then reconstructed.

The second, more radical surgery involves dissection of the pleura, pericardium and lung tissue. This procedure provides better local control of the cancer than Pleurectomy because the mesothelium tissue is removed.

Surgery alone has a low cure rate and most patients die within a few months. Many have evidence of metastatic tumors in other parts of their body.

Trimodal Treatment

Trimodal treatment is the combination of all three treatment modalities – chemotherapy, radiation and surgery. Studies using various combinations of trimodal treatment have shown survival rates that are better than any of the therapy modalities alone.

Advances in the treatment of mesothelioma continue to emerge. Only a few short years ago mesothelioma was considered an untreatable disease with no hope of survival beyond a few months from diagnosis. Though still a difficult disease to treat, the prospects of a mesothelioma patient today are significantly better than even 2 years ago.